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Definition
| HELPS TO COVER INPATIENT HOSPITAL CARE ,AS WELL AS CARE PROVIDED IN SKILLED NURSING FACILITIES,HOSPICE CARE, AND HOME HEALTHCARE. |
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Term
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Definition
| HELPS TO COVER MEDICALLY NECESSARY PHYSICIANS' SERVICES,OUT PATIENT CARE, AND OTHER MEDICAL SERVICES (INCLUDING SOME PREVENTIVE SERVICES) MEDICARE PART B IS AN OPTIONAL BENEFIT FOR WHICH THE PATIENT MUST PAY A PREMIUM,AND WHICH GENERALLY REQUIRES A YEARLY DEDUCTIBLE AND CO-INSURANCE. |
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Term
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Definition
| IS A PRECRIPTION DRUG COVERAGE PROGRAM AVAILABLE TO ALL MEDICARE BENEFICIARIES. PRIVATE COMPANIES APPROVED BY MEDICARE PROVIDE COVERAGE |
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Term
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Definition
| ALSO CALLED MEDICARE ADVANTAGE,COMBINES THE BENEFITS OF MEDICARE PART A,PART B, AND -SOMETIMES-PART D. THE PLANS ARE MANAGED BY PRIVATE INSURERS APPROVED BY MEDICARE. THE PLANS MAY CHARGE DIFFERENT CO-PAYMENTS, COINSURANCE, OR DEDUCTIBLES FOR SERVICES. |
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Term
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Definition
| MEDICARE PAYMENTS FOR PHYSICIAN SERVICES AND ARE STANDARDIZED USING A RESOURCE-BASED RELATIVE SCALE. RESOURCE COSTS ARE DIVIDED INTO 3 COMPONENTS: PHYSICIAN WORK,PRACTICE EXPENSE,AND PROFESSIONAL LIABILITY INSURANCE. |
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Definition
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Term
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Term
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Definition
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Term
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Definition
| GEOGRAPHIC PRACTICE INDEX (THIS IS USED TO REALIZE THE VARYING COST BASED ON GEOGRAPHIC LOCATION) |
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Term
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Definition
| CONVERSION FACTOR (THIS IS A FIXED DOLLAR AMOUNT USED TO TRANSLATE THE RVUs INTO FEES) |
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Term
| NON-FACILITY PRICING AMOUNT = |
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Definition
| [(WORK RVU*WORK GPCI)+(NON-FACILITY PE RVU*PE GPCI)+(MP RVU*MP GPCI)}*(CF) |
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Term
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Definition
| [(WORK RVU*WORK GPCI)+(FACILITY PE RVU*PE GPCI)+(MP RVU*MP GPCI)]*CF |
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Term
| PUBLISHED CONVERSION FACTOR FOR CY 2014 |
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Definition
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Term
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Definition
| REFERS TO WHETHER A PROCDURE OR SERVICE IS CONSIDERED APPROPIATE IN A GIVEN CIRCUMSTANCE. |
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